I did a survey for my MBA thesis in 1995 and to my surprise I found that patients (matched across social class by a gallop trained surveyor), and Professionals and Health Service Managers agreed on the need to ration health care even then. The power of the survey was not that great, with equal numbers of both groups at 200 each, or 400 in total. The important thing about FundHolding in our case, was that it worked by communication and co-operation with patients, through a Patient Participation Group (PPG). If we rationed out use of a drug, patients understood and rarely argued.. Deserts based rationing is different because it represents vertical equity, whereby unequals are treated unequally, rather than horizontal equity, whereby equals are treated equally. To bring it in for a population requires warning, pre-planning, and above all an ethical and philosophical discussion of the implications… think it through. Where will it lead? What about drug addicts? What happens if the whole population is obese? How will the politicians address this? – by denial of course.
Restricting care for people with unhealthy lifestyles is supported by six in ten people, according to a YouGov poll for The Times. Doctors branded the idea “morally wrong”, but leaders of patient groups said it was fair.
As our ageing population becomes sicker, the health service faces a £30 billion a year funding gap by the end of the decade, and has called on politicians to increase the NHS budget by £8 billion a year by 2020.
The poll of 1,642 people finds voters almost evenly split on whether taxes should rise to fund the increase, with 43 per cent in favour and 40 per cent against.
Labour stepped back from this option at last year’s party conference, targeting bankers and the city for an extra £2.5 billion instead.
Other ideas, such as charges to see a GP or reducing services offered by the NHS, are deeply unpopular, with less than 20 per cent in favour.
Forcing people who drink too much alcohol to cut down before offering treatment has the support of 64 per cent, with 26 per cent opposed. Almost 60 per cent believe fat people should be made to slim and smokers to quit before being treated, with only 29 per cent opposed. Tory voters are mostly likely to back rationing for the obese, with 74 per cent agreeing, but about half of Labour supporters are in favour.
Mark Porter, the chairman of the British Medical Association, said: “Losing weight or giving up smoking is an important consideration for patients needing treatment, but should not become a condition for receiving care.
“For someone addicted to nicotine, or dependent on alcohol, the choice and journey to quitting is far more difficult than for someone without a dependency. It is morally wrong to refuse treatment for these patients and by doing so we could be leaving some of the most vulnerable patients in a position where their health problem will only deteriorate and cause further pressure on the NHS.” Roger Goss, co-director of Patient Concern, a charity, disagreed. He said: “‘Own-goal’ ill health should be a lower priority than illness that’s come upon you simply because of your genes or bad luck. The argument is fairness. It’s your own fault if you won’t control your eating and drinking.
“We’ve always argued that the public and patients should be asked their priorities in terms of availability or treatments. But the powers that be won’t do this because the results would be politically incorrect.”
Health chiefs in Devon announced plans to refuse surgery to smokers and the morbidly obese unless they quit or lost weight, but backed down after an outcry.
Nigel Edwards, the chief executive of the Nuffield Trust health think tank, added: “The public are very much in favour of this . . . but they have a very different view when you show them a picture and tell them the story of someone who’s suffered because of it.”
Tam Fry, of the National Obesity Forum, said: “It’s very understandable to take the view that people should slim down before they get treated, but the problem with that is that when people are very overweight they don’t find it easy to slim down.”
With 66 per cent of the population overweight, Mr Fry added that many supporters of such plans might not realise they would lose out.